Colposcopy as an adjunctive diagnostic tool in the
assessment of cervical intraepithelial neoplasia is a significant aid
to the pelvic surgeon in selecting the appropriate method of therapy
in certain cases. Its use is indicated in all patients having abnormal
Papanicolaou cytologic smears or gross lesions.

To obtain accurate cytologic
specimens for study, the surgeon must be trained not only in performing
a colposcopy but also in selecting the proper instruments for the examination.

The purpose of the operation
is to visualize the cervix under high magnification and delineate abnormal
zones of cervical epithelium.

Endocervical curettage enables the surgeon to take
specimens from the endocervical canal that may not be visible even
with the colposcope.

Physiologic Changes. None.

Points of Caution. A direct Papanicolaou smear should
be taken prior to any manipulation of the cervix.

A detailed survey of the cervix should be performed prior to any surgical
manipulation.
The endocervical curettings should be sent as a second specimen.

Technique

The patient is placed on an
ordinary gynecologic examination table, and a nonlubricated speculum
is placed in the vagina. The colposcope is moved into appropriate
position and focused. A routine cytologic smear as well as a
wet mounted smear for Trichomonas and Monilia are
taken. The cervical mucus is then cleared by applying 4% acetic
acid to the cervix and removing the solution with either a small
suction cannula or a cotton-tipped applicator. The cervix is
studied carefully with the green filter lens in place to enhance
the appearance of the cervical blood vessels.

A sagittal section of the uterus and upper
vagina shows the area of the endocervix to be curetted. The cervix
should not be dilated, since dilation would increase the possibility
of the curet entering the endometrial cavity.

The endocervical curet is placed
in the cervix up to the internal os. The curet is moved back
and forth in the cervical canal, collecting tissue within the
rectangular box. The tissue is then sent to the pathologist.
This movement is repeated in a 360° circle
until the entire cervical canal has been curetted.